Christopher S Ogilvy

Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States

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Publications (267)787.41 Total impact

  • Adam M H Young, Surya K Karri, Christopher S Ogilvy
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    ABSTRACT: The hypothesis that alterations in hormone levels can impact on subarachnoid hemorrhage (SAH) is rapidly gaining momentum. Specifically, the concept that post-menopausal women are more susceptible to the condition has convinced many of the protective roles of estrogen and progesterone. Here we review the mechanisms of their actions and the potential for estrogen and progesterone replacement therapy in subarachnoid hemorrhage. Searches were performed using PubMed with the search terms "subarachnoid hemorrhage", "estrogen", "progesterone "treatment", "management", "cerebral aneurysm", and "vasospasm" from 1970 to February, 2012. Articles were also identified through searches of the Cochrane library and searches of the authors' own files. Only papers published in English were reviewed. In conclusion, there is significant theoretical evidence for the potential role of estrogen and progesterone use in altering the pathogenesis of SAH. Nevertheless, this has received mixed reviews in both case controlled studies and cohort analysis within the literature.
    Current drug safety. 08/2012;
  • S K Karri, A M H Young, C S Ogilvy
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    ABSTRACT: The signal transduction of tumor necrosis factor-alpha (TNF-alpha) is complex and regulated via a vast number of interconnecting pathways. The TNF-alpha signaling pathway plays a major role in the pathogenesis of subarachnoid hemorrhage (SAH). The advent of molecular mimicry has provided a number of opportunities to tackle disease with improved specificity. Here we review the mechanisms of their action and the potential for TNF-alpha inhibitors as a treatment for subarachnoid hemorrhage. Searches were performed using PubMed with the search terms "subarachnoid haemorrhage", "TNF alpha", "novel drugs"TNF alpha inhibition", "management", "cerebral aneurysm", and "vasospasm" from 1970 to February, 2012. Articles were also identified through searches of the Cochrane library and searches of the authors' own files. Only papers published in English were reviewed. In conclusion, there is considerable theoretical evidence for the potential of TNF-alpha inhibitors to impact on the pathogenesis of aneurismal SAH. Such indications demonstrate the potential for specific targeting of molecular signaling pathways to prevent the growth and rupture of cerebral aneurysm.
    Current drug safety. 08/2012;
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    ABSTRACT: Subarachnoid hemorrhage (SAH) is associated with inflammation that may mediate poor outcome in SAH. We hypothesize that elevated serum tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) are associated with vasospasm and poor outcome in SAH. In 52 consecutive SAH subjects, we compared TNF-α and IL-6 levels on post-SAH days 0 to 1, 2 to 3, 4 to 5, 6 to 8, and 10 to 14 with respect to vasospasm and to poor outcome at 3 and 6 months. Vasospasm was defined as more than 50% reduction in vessel caliber on angiography. Poor outcome was defined as modified Rankin score greater than 2. Elevated TNF-α on post-SAH days 2 to 3 was associated with poor 3-month outcome (P = 0.0004). Global elevation of TNF-α over time (post-SAH days 0-14) was independently associated with poor 3-month outcome after adjusting for Hunt-and-Hess grade and age (P = 0.02). Neither cross-sectional nor IL-6 levels over time were associated with outcome. Neither TNF-α nor IL-6 levels were associated with vasospasm. Elevation in serum TNF-α on post-SAH days 2 to 3 and global elevation of TNF-α over time are associated with poor outcome but not with angiographic vasospasm in this small cohort. Future studies are needed to define the role of TNF-α in SAH-related brain injury and its potential as a SAH outcome biomarker.
    Journal of Investigative Medicine 08/2012; 60(7):1054-8. · 1.50 Impact Factor
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    ABSTRACT: : Numerous studies show that transient exposure to mild ischemia renders the brain resistant to a subsequent more severe ischemic stimulus, a concept known as preconditioning. Excitingly, this phenomenon has recently been demonstrated in subarachnoid hemorrhage (SAH), as mice transiently exposed to hypoxia developed an eNOS-mediated reduction vasospasm and neurological deficits following experimental SAH; however, this has never been studied in humans. In the present study, we hypothesize that patients with pre-existent steno-occlusive vascular disease experience ischemic preconditioning resulting in reduced SAH-induced cerebral vasospasm. : Retrospective case-controlled data from five high-volume SAH centers from 2006 to 2011 were pooled. Only Fisher 3 to 4 patients were included. The effect of pre-existent steno-occlusive vascular disease (extra- and intra-cranial atherosclerotic disease, and peripheral vascular disease) on the following endpoints was studied: angiographic vasospasm, symptomatic vasospasm, and stroke. Multivariate logistic regression analysis was performed with the following covariables; age, gender, Hunt-Hess grade, neurological deficit on admission, aneurysm location and type of aneurysm treatment. : A total of 771 patients were included, of which 198 (25.7%) had pre-existent vascular disease, 573 (74.3%) did not. Of those patients that had pre-existent vascular disease, 49 (24.7%) developed radiographic vasospasm, 30 (15.2%) symptomatic vasospasm and 26 delayed stroke (13.1%). Of those patients that did not have pre-existent vascular disease, 245 (42.8%) developed radiographic vasospasm, 131 (22.9%) symptomatic vasospasm, 84 (14.7%) delayed stroke. Multivariate logistic regression analysis demonstrated that older age and pre-existent vascular disease were significantly related with protection from radiographic and symptomatic vasospasm. Patients with pre-existent vascular disease had lower incidence of radiographic vasospasm (odds ratio, 0.524; 95% CI, 0.361-.0761; P = .001) and symptomatic vasospasm (odds ratio, 0.584; 95% CI, 0.385-0.885, P = 0.011). : These retrospective case-controlled data are the first evidence in human patients that ischemic preconditioning has an effect on reducing the incidence of angiographic and symptomatic vasospasm in patients with aneurysmal SAH.
    Neurosurgery 08/2012; 71(2):E553. · 3.03 Impact Factor
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    ABSTRACT: Traumatic intracranial pseudoaneurysms in children are typically the result of blunt or penetrating head injury. There are isolated reports of pseudoaneurysm as the result of intracranial aneurysm surgery in both adults and children. Treatment of these lesions, both surgically and endovascularly, can be complicated due to the known variability of arterial wall thickness in traumatic pseudoaneurysms. We describe a child who underwent successful craniopharyngioma resection following staged surgical procedures. Follow-up imaging 8 months after the operation demonstrated an enlarging pseudoaneurysm of the left supraclinoid carotid artery. The lesion was successfully treated with stenting of the vessel and coil placement between the stent and the aneurysmal segment of the artery. Follow-up angiographic imaging 6 months later revealed complete obliteration of the aneurysm and normalization of the carotid artery lumen. To our knowledge, this is the first report of a pseudoaneurysm secondary to a surgical intervention in childhood that was treated with stent-assisted coiling. This strategy of vascular reconstruction is increasingly used in adults and appears safe to implement in the pediatric population. However, the long-term outcomes and the value of using an antiplatelet regimen in this young population are still to be determined.
    Pediatric Neurosurgery 07/2012; 47(6):442-8. · 0.50 Impact Factor
  • Surya Karri, Christopher S Ogilvy
    Current drug safety. 07/2012; 7(3):189.
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    ABSTRACT: Recurrence after endovascular coiling of intracranial aneurysms is reported in up to 42% of cases and is attributed to the lack of endothelialization across the neck. In this study the authors used a novel tissue engineering approach to promote endothelialization by seeding endothelial progenitor cells (EPCs) within a fibrin polymer injected endovascularly into the aneurysm. Experimental aneurysms were created in New Zealand White rabbits and were left untreated, surgically clipped, or embolized with platinum coils, fibrin biopolymer alone, or fibrin combined with autologous cultured EPCs. In aneurysms treated with EPCs, a confluent monolayer of endothelial cells with underlying neointima was demonstrated across the neck at 16 weeks posttreatment, which was not observed with aneurysms treated using the other methods. This novel technique may address reasons for the limited durability of standard coil embolization and provides further avenues for the development of improved devices for the care of patients with aneurysms.
    Journal of Neurosurgery 06/2012; 117(3):546-54. · 3.15 Impact Factor
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    ABSTRACT: Most intracranial aneurysms (IA) that present unruptured at the clinic remain stable over time with no measurable change or symptoms, if left untreated. But a few do grow larger and occasionally rupture. The ability to preemptively identify aneurysms that will become unstable over time (i.e., those that will grow and/or rupture) can result in timely intervention for these few patients while avoiding unnecessary treatment for countless others [1]. Previous reports assessing potential factors including by our group [2–4] have been confined to comparing geometric and/or biomechanical indices of aneurysms between populations that presented with ruputred lesions from those that presented with unruptured lesions. But, such indices (that discriminate rupture ‘status’) need not necessarily distinguish unruptured aneurysms that fork toward growth and/or rupture over a period of time from those that remain stable over time. Further, the physician’s dilemma to treat or not to treat presents itself mostly only in small aneurysms (< 7mm).
    ASME 2012 Summer Bioengineering Conference; 06/2012
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    ABSTRACT: The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH). A formal literature search of MEDLINE (November 1, 2006, through May 1, 2010) was performed. Data were synthesized with the use of evidence tables. Writing group members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council's Levels of Evidence grading algorithm was used to grade each recommendation. The guideline draft was reviewed by 7 expert peer reviewers and by the members of the Stroke Council Leadership and Manuscript Oversight Committees. It is intended that this guideline be fully updated every 3 years. Evidence-based guidelines are presented for the care of patients presenting with aSAH. The focus of the guideline was subdivided into incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, anesthetic management during repair, management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications. aSAH is a serious medical condition in which outcome can be dramatically impacted by early, aggressive, expert care. The guidelines offer a framework for goal-directed treatment of the patient with aSAH.
    Stroke 05/2012; 43(6):1711-37. · 6.02 Impact Factor
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    ABSTRACT: PURPOSE: To evaluate the efficacy of n-butyl-2-cyanoacrylate (Trufill n-BCA) versus ethylene vinyl alcohol copolymer (ONYX) for the embolization of cranial dural arteriovenous fistulas (DAVF). METHODS: Fifty-three consecutive patients with cranial dural AVF were treated with liquid embolic agents from November, 2003 to November, 2008. These 53 patients had 56 lesions treated with arterial embolization. Patients embolized to completion underwent follow-up angiography at 3 months to assess for durable occlusion. RESULTS: Twenty-one lesions were treated with n-BCA. Seven patients treated with n-BCA had initial angiographic occlusion of their DAVF, which were durable at 3 months. Six patients had adjunctive treatment with coils and/or polyvinyl alcohol particles, but none of these were occluded by endovascular treatment alone. Eleven patients underwent post-embolization surgery for closure of their DAVF. There was one death related to intractable status epilepticus at presentation. One patient developed a major stroke from venous sinus thrombosis after embolization. Thirty-five lesions were treated with ONYX in 34 patients. Twenty-nine patients treated with ONYX had initial angiographic occlusion of their DAVF by embolization alone. One patient had recurrence at 3 months and was re-treated out of 27 total follow-ups. Four patients underwent post-embolization surgical obliteration of their lesions. No deaths or major strokes occurred in this cohort. CONCLUSION: Initial angiographic occlusion (p=0.0004) and durable angiographic occlusion (p=0.0018) rates for embolization of cranial DAVF show a statistically significant higher efficacy with ONYX compared with n-BCA. Patients embolized with ONYX underwent surgery less frequently compared with those treated with n-BCA (p=0.0015).
    Journal of Neurointerventional Surgery 05/2012; · 2.50 Impact Factor
  • David H Jho, Christopher S Ogilvy
    Journal of Neurointerventional Surgery 03/2012; · 2.50 Impact Factor
  • John C Barr, Christopher S Ogilvy
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    ABSTRACT: This article provides management guidelines for arteriovenous malformations (AVMs). Management options include observation, surgical excision, endovascular embolization, and radiosurgery. Each of these can be used individually or combined for multimodal therapy based on the characteristics of the lesion. The article stratifies each lesion based on the AVM and patient characteristics to either observation or a single or multimodal treatment arm. The treatment of an AVM must be carefully weighed in each patient because of the risk of neurologic injury in functional areas of the brain and weighed against the natural history of hemorrhage.
    Neurosurgery clinics of North America 01/2012; 23(1):63-75. · 1.73 Impact Factor
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    ABSTRACT: To evaluate patients with high-risk cerebral arteriovenous malformations (AVMs), based on eloquent brain location or large size, who underwent planned two-fraction proton stereotactic radiosurgery (PSRS). From 1991 to 2009, 59 patients with high-risk cerebral AVMs received two-fraction PSRS. Median nidus volume was 23 cc (range, 1.4-58.1 cc), 70% of cases had nidus volume ≥ 14 cc, and 34% were in critical locations (brainstem, basal ganglia). Median AVM score based on age, AVM size, and location was 3.19 (range, 0.9-6.9). Many patients had prior surgery or embolization (40%) or prior PSRS (12%). The most common prescription was 16 Gy radiobiologic equivalent (RBE) in two fractions, prescribed to the 90% isodose. At a median follow-up of 56.1 months, 9 patients (15%) had total and 20 patients (34%) had partial obliteration. Patients with total obliteration received higher total dose than those with partial or no obliteration (mean dose, 17.6 vs. 15.5 Gy (RBE), p = 0.01). Median time to total obliteration was 62 months (range, 23-109 months), and 5-year actuarial rate of partial or total obliteration was 33%. Five-year actuarial rate of hemorrhage was 22% (95% confidence interval, 12.5%-36.8%) and 14% (n = 8) suffered fatal hemorrhage. Lesions with higher AVM scores were more likely to hemorrhage (p = 0.024) and less responsive to radiation (p = 0.026). The most common complication was Grade 1 headache acutely (14%) and long term (12%). One patient developed a Grade 2 generalized seizure disorder, and two had mild neurologic deficits. High-risk AVMs can be safely treated with two-fraction PSRS, although total obliteration rate is low and patients remain at risk for future hemorrhage. Future studies should include higher doses or a multistaged PSRS approach for lesions more resistant to obliteration with radiation.
    International journal of radiation oncology, biology, physics 11/2011; 83(2):533-41. · 4.59 Impact Factor
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    ABSTRACT: Cerebral cavernous malformations (CCM) are known to occur in both sporadic and familial forms. To date, there has been no identified association of CCM with glioblastoma multiforme. We present a 69-year-old woman with a 14 year history of multiple CCM who developed progressive aphasia. She had no radiation exposure and had only undergone a single computed tomography scan in her entire life. MRI demonstrated irregular gadolinium enhancement in the area of a prior stable CCM, suspicious for a high grade tumor. Stereotactic biopsy revealed a glioblastoma multiforme. This is a unique case of glioblastoma multiforme arising from the "site" of a known CCM. We review the literature on the genetics of cavernous malformations and propose a mechanism for the tumorigenic potential of these vascular malformations.
    Journal of Clinical Neuroscience 11/2011; 19(6):884-6. · 1.32 Impact Factor
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    ABSTRACT: To examine whether multiple aneurysms located in the anterior cerebral artery (ACA), middle cerebral artery (MCA), or internal carotid artery (ICA) could be treated through single-stage, ipsilateral dual craniotomies. Investigators reviewed records of nine patients who underwent dual ipsilateral craniotomies through one incision for surgical treatment of multiple aneurysms in the anterior circulation at a single institution from 1994-2010. In all cases, a single-stage pterional and frontal interhemispheric approach through two separate, ipsilateral craniotomies under a single, extended pterional incision was used. Dual craniotomies through one incision were performed on nine patients with multiple aneurysms without complications. This series included eight women and one man with an average age of 57 years. The mean number of aneurysms treated was 2.7 (range 2-5 aneurysms). Most patients underwent elective treatment. The pterional craniotomy approach was used to treat MCA and ICA aneurysms, whereas distal ACA aneurysms were treated through the frontal parasagittal craniotomy approach. All aneurysms were successfully treated via clip ablation. There were no perioperative or postoperative complications at an average follow-up of 29 months (range 1-131 months). Single-stage, ipsilateral dual pterional and frontal craniotomies through one incision constitute a safe approach that can be employed for the effective surgical treatment of multiple aneurysms in joint unilateral and axial locations with excellent clinical results.
    World Neurosurgery 11/2011; 77(3-4):502-6. · 2.42 Impact Factor
  • Fuel and Energy Abstracts 10/2011; 81(2).
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    ABSTRACT: While the trend for endovascular therapy of posterior circulation aneurysms is permeating, cerebrovascular bypass remains essential in the armamentarium for complex lesions not amendable to these techniques. This review discusses the microsurgical anatomy of the posterior fossa intracranial circulation, as well as the techniques and outcomes related to cerebrovascular bypass.
    Journal of Neurointerventional Surgery 09/2011; 3(3):249-54. · 2.50 Impact Factor
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    ABSTRACT: A significant number of patients with aneurysmal subarachnoid hemorrhage are active smokers and at risk for acute nicotine withdrawal. There is conflicting literature regarding the vascular effects of nicotine and theoretical concern that it may worsen vasospasm. The literature on the safety of nicotine replacement therapy and its effects on vasospasm is limited. A retrospective analysis was conducted of a prospectively collected database of aneurysmal subarachnoid hemorrhage patients admitted to the neurointensive care unit from 1994 to 2008. Paired control subjects matched for age, sex, Fisher score, aneurysm size and number, hypertension, and current medication were analyzed. The primary outcome was clinical and angiographic vasospasm and the secondary outcome was Glasgow Outcome Score on discharge. Conditional logistic models were used to investigate univariate and multivariate relationships between predictors and outcome. Two hundred fifty-eight active smoking patients were included of which 87 were treated with transdermal nicotine replacement therapy. Patients were well matched for age, sex, gender, Fisher score, aneurysm size and number, hypertension, and current medications, but patients who received nicotine replacement therapy had less severe Hunt-Hess scores and Glasgow coma scores. There was no difference in angiographic vasospasm, but patients who received nicotine replacement therapy were less likely to have clinical vasospasm (19.5 versus 32.8%; P=0.026) and a Glasgow Outcome Score <4 on discharge (62.6% versus 81.6%; P=0.005) on multivariate analysis. Nicotine replacement therapy was not associated with increased angiographic vasospasm and was associated with less clinical vasospasm and better Glasgow Outcome Score scores on discharge.
    Stroke 08/2011; 42(11):3080-6. · 6.02 Impact Factor
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    ABSTRACT: Recently introduced fpVCT scanners can capture volumetric (4D) time-varying projections enabling whole-organ dynamic CTA imaging. The main objective of this study was to assess the temporal resolution of dynamic CTA in discriminating various phases of rapid and slow time-dependent neurovascular pathologies in animal models. Animal models were created to assess phasic blood flow, subclavian steal phenomena, saccular aneurysms, and neuroperfusion under protocols approved by the SRAC. Animals with progressively increasing heart rate-Macaca sylvanus (~100 bpm), Oryctolagus cuniculus (NZW rabbit) (~150 bpm), Rattus norvegicus (~300 bpm), Mus musculus (~500 bpm)-were imaged to challenge the temporal resolution of the system. FpVCT, a research prototype with a 25 × 25 × 18 cm coverage, was used for dynamic imaging with the gantry rotation time varying from 3 to 5 seconds. Volumetric datasets with 50% temporal overlap were reconstructed; 4D datasets were analyzed by using the Leonardo workstation. Dynamic imaging by using fpVCT was capable of demonstrating the following phenomena: 1) subclavian steal in rabbits (ΔT ≅ 3-4 seconds); 2) arterial, parenchymal, and venous phases of blood flow in mice (ΔT ≅ 2 seconds), rabbits (ΔT ≅ 3-4 seconds), and Macaca sylvanus (ΔT ≅ 3-4 seconds); 3) sequential enhancement of the right and left side of the heart in Macaca sylvanus and white rabbits (ΔT ≅ 2 seconds); and 4) different times of the peak opacification of cervical and intracranial arteries, venous sinuses, and the jugular veins in these animals (smallest, ΔT ≅ 1.5-2 seconds). The perfusion imaging in all animals tested was limited due to the fast transit time through the brain and the low contrast resolution of fpVCT. Dynamic imaging by using fpVCT can distinguish temporal processes separated by >1.5 seconds. Neurovascular pathologies with a time constant >1.5 seconds can be evaluated noninvasively by using fpVCT.
    American Journal of Neuroradiology 08/2011; 32(9):1688-96. · 3.17 Impact Factor
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    ABSTRACT: This article describes delayed endovascular revascularization in a patient with clinical and radiographic evidence of posterior circulation hemodynamic failure in the setting of intracranial occlusive lesions. A 48-year-old man presented with a 6-week history of progressive headache, nausea, and ataxia. Bilateral intracranial vertebral artery occlusions and a left posterior inferior cerebellar artery stroke were diagnosed, and the patient began warfarin therapy. Despite these measures, the patient developed dense lower cranial neuropathies, including severe dysarthria, decreased left-sided hearing acuity, and left facial droop. He presented at this point for endovascular evaluation. The patient underwent successful revascularization with intravascular Wingspan stents (Boston Scientific, Natick, Massachusetts) in a delayed fashion (approximately 6 weeks after his initial stroke presentation). His neurological syndrome stabilized and began to improve slowly. Patients with arterial occlusion should be evaluated acutely for potential revascularization. In the posterior circulation, clinical progression may supplant physiological imaging in the assessment of hemodynamic collapse. A subpopulation of patients will present with progressive deficits distinct from extracranial manifestations of vertebrobasilar insufficiency; these patients should be considered for delayed revascularization.
    Neurosurgery 07/2011; 69(1):E251-6; discussion E256. · 3.03 Impact Factor

Publication Stats

5k Citations
787.41 Total Impact Points


  • 2008–2014
    • Beth Israel Deaconess Medical Center
      • • Division of Neurosurgery
      • • Department of Emergency Medicine
      Boston, Massachusetts, United States
  • 1996–2014
    • Harvard Medical School
      • Department of Neurology
      Boston, Massachusetts, United States
    • University of Massachusetts Boston
      Boston, Massachusetts, United States
  • 1988–2014
    • Massachusetts General Hospital
      • • Department of Radiology
      • • Department of Neurosurgery
      • • Department of Neurology
      • • Neurology of Vision Lab
      Boston, Massachusetts, United States
  • 2013
    • University of Costa Rica
      San José, San José, Costa Rica
    • Thomas Jefferson University
      • Department of Neurological Surgery
      Philadelphia, Pennsylvania, United States
    • University of Cambridge
      • School of Clinical Medicine
      Cambridge, ENG, United Kingdom
  • 2012
    • Mass General Hospital
      Boston, Massachusetts, United States
    • Partners HealthCare
      Boston, Massachusetts, United States
  • 2011
    • University of Pennsylvania
      Philadelphia, Pennsylvania, United States
  • 2010–2011
    • State University of New York
      New York City, New York, United States
  • 2009–2011
    • University at Buffalo, The State University of New York
      • Department of Neurosurgery
      Buffalo, NY, United States
  • 2007
    • Centre hospitalier de l'Université de Montréal (CHUM)
      Montréal, Quebec, Canada
  • 2006
    • University of Southern California
      • Department of Neurological Surgery
      Los Angeles, CA, United States
  • 1996–2003
    • University of California, San Francisco
      • Department of Neurological Surgery
      San Francisco, CA, United States
  • 1990–2003
    • Beverly Hospital, Boston MA
      Beverly, Massachusetts, United States
  • 1998
    • Washington University in St. Louis
      San Luis, Missouri, United States